Generic Name

Ganciclovir

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Classification

FDA Approved Indications

• Treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients
• Prevention of CMV disease in organ transplant recipients

Mechanism of Action

Ganciclovir inhibits viral DNA polymerase after being phosphorylated by viral kinases, leading to termination of viral DNA synthesis.

Dosage and Administration

Adult: Typically 5 mg/kg IV every 12 hours for 14-21 days, then maintenance dosing as per protocol

Pediatric: Dosing varies based on weight and age; usually 5 mg/kg IV every 12 hours, adjusted for renal function

Geriatric: Dose adjustments based on renal function; increased monitoring advised

Renal Impairment: Dose reduction required based on creatinine clearance

Hepatic Impairment: Use with caution; no specific dose adjustment established

Pharmacokinetics

Absorption: Poor oral bioavailability (~6%), IV administration common

Distribution: Widely distributed including eye and CSF; crosses blood-brain barrier

Metabolism: Minimal hepatic metabolism; primarily renal excretion

Excretion: Renal excretion of unchanged drug; dose adjustment needed in renal impairment

Half Life: 3-4 hours in patients with normal renal function

Contraindications

• Hypersensitivity to ganciclovir or valganciclovir

Precautions

• Bone marrow suppression, renal impairment, active infections, pregnancy and lactation (category C)

Adverse Reactions - Common

• Bone marrow suppression (neutropenia, thrombocytopenia, anemia) (Common)
• Headache, fever, nausea (Common)

Adverse Reactions - Serious

• Severe neutropenia, anemia, thrombocytopenia leading to infections or bleeding (Serious and warrants monitoring)
• Renal toxicity (Serious, especially in renal impairment)
• Neurotoxicity (confusion, hallucinations) (Rare)

Drug-Drug Interactions

• Mycophenolate mofetil, zidovudine, other marrow suppressants

Drug-Food Interactions

• None significant

Drug-Herb Interactions

• None established

Nursing Implications

Patient/Family Teaching

• Report fever, sore throat, unusual bleeding or bruising
• Maintain hydration to support renal function
• Adhere to scheduled monitoring appointments

Special Considerations

Black Box Warnings:

• Myelosuppression, fertility impairment, carcinogenic and mutagenic risks

Genetic Factors: None established impacting use

Lab Test Interference: May cause false elevation in blood urea nitrogen and serum creatinine

Overdose Management

Signs/Symptoms: Severe bone marrow suppression, neurotoxicity, renal failure

Treatment: Supportive care, discontinue drug, consider hemodialysis for severe cases

Storage and Handling

Storage: Store at room temperature, protect from light and moisture

Stability: Consult manufacturer data for specific stability info